Topics in Geriatrics: Dementia Screening

Dementia screening tools are used to screen for cognitive impairment, diagnosis of dementia and document change over time. These tests will help to decipher if someone has normal age related memory problems or more severe type of memory problems.

Objectives:
The objectives of this page are to:

1 Learn more about dementia screening tools
2 Learn how to administer dementia screening tests
3 Learn how assessments are scored and cut off criteria
4 Learn the validity of the tests
5 Learn what test to choose for different populations

Screening Tools

The Abbreviated Mental Test Score (AMTS)
GOLD STANDARD FOR CLINICAL DIAGNOSIS
10 items scored with either a 0 or 1.
0= didn’t answer question correctly 1= correct answer
  • Assess orientation, registration, recall and concentration
  • Any clinician is able to administer test
  • Takes approximately 3-4 min to complete
  • Available on mobile application

Scoring
Max score =10
> 6 = Normal
4-6 = Moderate impairment
0-3 = Severe impairment

Validity
Specificity: .95
Sensitivity: .79
* Low positive predicative value, need second assessment to confirm diagnosis

Link to AMTS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560932/pdf/occpaper00113-0035.pdf

Clock Drawing Test
Assesses visuo-spatial deficits- early sign of dementia
  • Evaluates a small area of the cognitive realm related to dementia; many other conditions may affect testing (stroke)

There are different ways to administer the test. One way to administer test:
  • Patient given paper with circle on it
  • Orient patient to top of page
  • Ask to draw numbers on the clock
  • Ask to draw hour and min hands for it to read “10 after 11”

Scoring
Max Score= 6
≥ 3 = cognitive deficit
1-2 = normal

Validity
Specificity: .96
Sensitivity: .86

Link to Clock Drawing Test
https://www.healthcare.uiowa.edu/igec/tools/cognitive/clockDrawing.pdf

Montreal Cognitive Assessment
Screens for mild cognitive impairment (MCI) and vascular dementia
  • Assesses attention, concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations and orientation
  • Takes 10 min to administer
  • More sensitive than MMSE

Scoring
Max Score: 30
>26 = normal
1-25 = impaired

Validity
Specificity: .90 - .96
Sensitivity: .87

Link to Montreal Cognitive Assessment
http://www.mocatest.org

Mini Mental State Examination (MMSE)
Brief screening tool NOT diagnostic tool
Should be used to document changes over time
  • More valid the increased severity of the cognitive impairment
  • Assesses orientation, memory, attention, calculation, language and visual construction
  • Widely used tool throughout the world
  • Scored impacted by age, education, cultural background

Scoring
Max Score: 30
<24 = normal
18-23 = mild impairment
0-17 = severe impairment

Validity
Specificity: .91
Sensitivity: .69
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1992.tb01992.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+11th+July+2015+at+10%3A00-16%3A00+BST+%2F+05%3A00-11%3A00+EDT+%2F+17%3A00-23%3A00++SGT++for+essential+maintenance.++Apologies+for+the+inconvenience&userIsAuthenticated=false&deniedAccessCustomisedMessage=

Link to MMSE
http://www.mountsinai.on.ca/care/psych/on-call-resources/on-call-resources/mmse.pdf





References:

1. http://ageing.oxfordjournals.org/content/27/3/399.full.pdf
2. http://www.ncbi.nlm.nih.gov/pubmed/17542384
3.http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8747599&fileId=S135561771200077X
4.http://consultgerirn.org/uploads/File/trythis/try_this_3_2.pdf
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587038/
6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487532/